ABSTRACT
High doses of heparin are recommended during coronary angioplasty although platelet inhibition seems to play a role in the prevention of ischaemic complications. Low dose heparin could reduce the incidence of local complications without increasing that of major coronary events. The authors report the results of a prospective register of coronary angioplasties performed by the femoral approach with a single bolus of 30 IU/Kg of heparin and immediate withdrawal of the 6 French introducer. Only patients with recent infarction or left main stem disease were excluded. All underwent clinical examination and ultrasonic scanning of the puncture site the day after the procedure. Four hundred and eighteen patients were included (mean age: 63.3 +/- 11 years; 79% men; 77% stenting). The average dose of heparin was 2253 +/- 1056 IU; the average procedure time was 25 +/- 16 minutes, and a final activated clotting time was 174 +/- 69 ms. The duration of normal compression was 7.7 +/- 3 min. Eighty-three point five per cent of patients were discharged the day after the procedure with a global cardiovascular complication rate of 2.87%. At 1 month, 1.67% of secondary cardiovascular events was recorded. Ultrasonography of the puncture site was abnormal in 7.6% of patients. Only one serious vascular complication (0.24%) requiring transfusion and surgical repair, was observed. The authors conclude that the use of low dose heparin appears effective and safe in cases without acute myocardial infarction. This protocol allows faster mobilisation and earlier hospital discharge of patients.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Anticoagulants/pharmacology , Heparin/pharmacology , Postoperative Complications/prevention & control , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Female , Heparin/administration & dosage , Heparin/adverse effects , Humans , Length of Stay , Male , Middle Aged , Patient DischargeSubject(s)
Cardiac Catheterization/instrumentation , Coronary Angiography/instrumentation , Mammary Arteries/diagnostic imaging , Equipment Design , Equipment Failure Analysis , Humans , Myocardial Revascularization/instrumentation , Postoperative Complications/diagnostic imaging , Sensitivity and SpecificityABSTRACT
The in situ or free gastroepiploic artery (GEA) is being used as an arterial conduit for coronary artery bypass surgery (CABG). The recent rapid improvements in stent manufacture, particularly their profile and flexibility, and related equipment, have helped reduce complications of coronary angioplasty. We describe one case of successful stenting of an in situ GEA-posterior descending artery graft. Stenting of an in situ GEA graft may avoid an incomplete result of angioplasty with possible restenosis or the need for multiple surgical revascularization. The use of stents in GEA grafts with 6 Fr soft guiding catheters can be encouraged.
Subject(s)
Angina, Unstable/therapy , Angioplasty, Balloon, Coronary/instrumentation , Arteries/transplantation , Coronary Artery Bypass , Coronary Disease/surgery , Graft Occlusion, Vascular/therapy , Postoperative Complications/therapy , Stents , Angina, Unstable/diagnostic imaging , Coronary Angiography , Coronary Disease/diagnostic imaging , Equipment Design , Female , Graft Occlusion, Vascular/diagnostic imaging , Humans , Middle Aged , Postoperative Complications/diagnostic imaging , RetreatmentABSTRACT
The inclusion criteria of this study were a left ventricular ejection fraction of less than 40% with global left ventricular hypokinesis; left ventricular aneurysms and valvular lesions were excluded. From January 1970 to December 1990, 155 patients fulfilling these criteria had Class III or IV angina and 49 patients had Class II or III dyspnoea. The average left ventricular ejection fraction was 31 +/- 7%. Over this 20 year period two surgical techniques were used: Group I (79 patients operated between 1970 and 1981) myocardial revascularisation with intermittent aortic clamping by an internal mammary artery pedicle on the left anterior descending artery and simple venous bypass grafts; Group II (76 patients operated between 1982 and 1990) myocardial revascularisation under oxygenated cardioplegia by internal mammary artery pedicle on the left anterior descending artery associated with sequential venous bypass grafts. The average number of bypass grafts was 1.6 in Group I and 3.7 in Group II (p = 0.001). The early postoperative mortality (first month) was 5.2% it was lower in Group II (2.6%) than in Group I (7.6%) (p = 0.01). After 79 +/- 14 months follow-up, 6 patients were lost to follow-up, 51 patients had died secondarily and there were 90 survivors. Globally, 80% of deaths were of cardiac origin, 38% from cardiac failure. The actuarial 5, 10 and 15 year survival rates were 79 +/- 7%, 63 +/- 10% and 36 +/- 15% respectively. The 5 year survival in Group I was 71 +/- 10% compared with 88 +/- 8% in Group II (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
